Too little research has been performed to determine exactly what hospice practices and services make the biggest impact on patient outcomes. While the Affordable Care Act requires hospices to report on specific practices being used, they do not require information on how these practices ultimately affect patients. A research team at the Icahn School of Medicine at Mount Sinai recently set out to determine how these hospice practices influenced patients' hospitilzations and which were the most beneficial. 

To begin, the researchers segmented a group of about 150 thousand Medicare beneficiaries enrolled in hospices throughout the US. Those that were studied entered hospice between 2008 and 2011 and were tracked until their deaths. The team noted each patient's hospital admittal, both emergency department visits and intensive care unit stays, and the location of each death. 

They studied six hospice practices, but of that group, only two were determined to make a significant impact on a patient's need for hospital admittance. 

First, hospices that talked to their patients about their preference on dying at home versus in a hospital or nursing facility reported lower odds of hospital deaths for their patients. Interestingly, those hospices also were determined to have lower odds of emergency department visits while a patient was enrolled in hospice care. 

Second, hospices that regularly monitored a patient's symptoms, at intervals at least every few days, showed lower odds of patients being admitted to the ICU. 

Neither of these are complex processes, but these findings suggesting they can have a significant impact on a patient's end of life care and quality of life can be used by hospices nationwide to lower hospitalization costs and improve the quality of care for patients. 

Ensuring that all hospices deliver these beneficial practices to each patient would have an enormous impact due to the growing rate of hospice use in the US. Hospice enrollment has grown by 20% over the past decade, and about 45 percent of terminally ill patients in the US die under hospice care. 

The results of this study suggest that not every hospice is created equal, and that the specific services and practices offered should be a determinant for individual's before enrolling themselves or their loved ones. 

To learn about our practices, goals, and philosophy of care at Cura-HPC, we invite you to contact us to schedule a consultation: (800) 797-3839. 

We often urge people to begin planning for end of life care, and researching care options like hospice and palliative care well before they or their loved ones actually need it. This way, your research can be conducted with less stress, and you can take your time interviewing medical professionals, discussing your options with your family, and ensuring you're making the right choices. That process typically begins with an open conversation about death and dying, which is a topic that many of us shy away from for as long as possible. Death isn't seen as a fun topic to discuss, but a conversation with your loved ones about your wishes, needs, and hopes is extremely valuable. Here are a few reasons why. 

Make choices 

There are typically two groups that are in desperate need of a frank, open discussion about death. First is the individuals who have thought about it themselves, made some decisions, but haven't communicated those choices to their family or doctor. This group risks becoming ill and not being able to tell those around them how they'd like to be treated. The other group is the individuals who have completely avoided thinking about death, end of life medical care, and other arrangements. This group risks creating a stressful, confusing experience for their loved ones when they near death. Both groups need to plan a discussion about their death, but what should be discussed and decided? Run through these common questions and communicate your choices: 

• Do I have a will in place? 
• Do I have plans or specific wishes for my funeral? 
• What type of medical care do I want to receive? 
• Do I want to be an organ donor? 
• Have I planned for financial and tax issues?
• Am I properly insured? 
• Have I put these wishes in writing, and communicated them to my family and physician? 

Find opportunities

Thinking about these topics and discussing them isn't only about planning for your death. There's also the benefit that thinking along these lines can illuminate opportunities that help you live better. You may begin to put more emphasis on having buket list type experiences. You may stop putting off that once in a lifetime trip, or finally learn a skill you've been dreaming about. Talking about death and dying can help you see clearly what regrets you'd have if your life ended today. If that leads to amazing experiences, or reconnecting with loved ones you've lost touched with, it makes your conversation about death well worth it. 

Reduce stress

When an individual gets ill, it's often a stressful time for everyone involved. Making these plans ahead of time, and discussing them with your loved ones, greatly reduces these stressful moments for you and your family. Having this conversation can even help to identify concerns that you or others may already be stressed about. Once identified, you can be sure to make plans and alleviate that stress. Then, once your decisions are needed, your family will already have plans in place and can spend more time with you and less time scrambling to make arrangements. 

To learn about hospice and palliative care in Oklahoma, contact us at Cura-HPC: 800-797-3839. 

You likely already know that your diet has a significant effect on your health. Not only does the food we eat influence how we feel today, but it also influences our long term health. Research conducted by a European project, NU-AGE, recently looked into the Mediterranean diet and it's health benefits in the long term. Their findings suggest that sticking to a strict Mediterranean diet could slow down the aging process and keep bones healthier as we age. 

First, a few notes on the Mediterranean diet. The most notable emphasis is a limitation of red meat. Those following the diet include red meat in their meals only a handful of times each month. Instead, fish is eaten on a regular basis, especially species that are rich in omega-3 fatty acids, which includes salmon, mackerel, albacore tuna and trout. Additional protein is taken from legumes and nuts. Fruits, vegetables, and whole grains are also prioritized in each meal. Butter is ideally removed completely and healthy fats like olive oil are used as alternatives. Salt is also removed or extremely limited and food is instead flavored with herbs and spices. 

Previous studies have revealed that this type of diet reduces the risk of many varieties of heart disease, but NU-AGE also concluded that C-reactive protein, an inflammatory marker linked with ageing, significantly decreased. The rate of bone loss for those with osteoporosis was also reduced. 

To reach these findings researchers recruited 1142 participants over the age of 65 across five European countries, France, Italy, Netherlands, Poland and the UK. Each individual was instructed to follow a personally tailored Mediterranean style diet. 

In addition to findings directly related to health, researchers also learned of significant differences between nutrition education that exists between residents of different countries and in different socio-economic groups. For example, more than 70 percent of French and British participants responded that their nutrition knowledge was high, whereas only about 30 percent said the same in Poland. Participants from the UK and Netherlands scored the highest on the understanding of nutrition information and food labels, while Italian participants scored the lowest. 

While this particular study exposed differences in European countries, similar conclusions can be drawn about different groups in the US. There certainly exists a different understanding and trust of food labels in different parts of the country. This lack of nutrition education can increase the likelihood of unhealthy diets, which raises the risks for a number of health issues later in life. 

At Cura-HPC, we provide hospice and palliative care to those with life-limiting illnesses. To learn more about the services we provide and gain insight into whether they're right for you or a loved one, contact us at (800)797-3839. 

There have been multiple studies that attempt to quantify the positive effects hospice care has on patients in the last weeks and months of their lives. While some have focused on the amount of time a patient may enjoy in hospice care, a study conducted by Yale researchers has been used to show how quality of life is impacted by hopsice through decreased symptoms. The Precipitating Events Project, PEP, enrolled 754 adults over the age of 70, who lived in the community, rather than an in-patient facility or nursing home, and were not disabled. These participants were interviewed monthly until their death about their health. The results of this study have allowed for a number of subsequent studies into what impacts a person's life and health in the months before death. Here, we focus on a study recently published in the American Journal of Medicine, which tracked the monthly occurrence of symptoms in these individuals and how those symptoms changed after enrollment in hospice care. 

The results of this study show two things. First, for most individuals, hospice care was reserved for a time when the number and prevelence of symptoms that restrict daily activity increased sharply. For example, the mean number of activity limiting symptoms rose from one to three over a three month period immediately prior to hospice enrollment. The prevelence of any activity limiting symptom rose from about 25-percent to over 50-percent in the same time period. 

Second, the data shows that following hospice enrollment, these same metrics decreased sharply and nearly returned to the levels of four months prior to enrollment. Over the first 90 days in hospice care, the number of symptoms fell to less than two. In the same period, the prevelence of symptoms dropped more than 20-percent. It should be noted that patients typically required up to a month to begin seeing significant reductions in their acitivity limiting symptoms. 

The first takeaway is not surprising. Families and patients typically wait to enroll in hospice until the quality of life of the patient has been significant affected. The Hospice Medicare benefit also doesn't allow for enrollment until a patient receives a diagnosis with a life expectancy of 6 months or less. 

Even so, the mean time from admission in hospice care to death was only about 15 days. This means that many patients both don't receive the full benefit of hospice care, and spend an unnecessary amount of time battling limiting symptoms before enrolling in hospice. 

The second takeaway is made even more meaningful when you examine the specific symptoms that hospice helps to reduce. The most common symptoms affected by hospice for participants in this study were fatigue, depression, anxiety, and arm or leg weakness. Each of these directly contributes to a patient's quality of life, and, as they improve, introduce opportunities to enjoy activities they otherwise would have missed out on. 

In addition to these findings, the PEP data has been instrumental in other research, including disability trajectories in the last year of life, and the prevelence of dyspnea in older adults in the last year of life. 

If you or a loved one are in need of hospice or palliative care, or if you'd like to research these care options, please contact us at Cura-HPC by calling 1-800-797-3839. 

Alzheimer's disease leads to cognitive decline and mental deterioration that significantly impacts an individual's personal life, and health. While there's not currently a cure for Alzheimer's, a great deal of research is being conducted to get closer to finding one. In the meantime, treatment and management of this disease improves greatly when it's caught in its early stages. Recent breakthroughs in testing have allowed for earlier diagnoses. Here are the details of two of these advances. 

Biomarkers

Also referred to as their full name, biological markers, these genes or molecules represent a tremendous opportunity in Alzheimer's research because of their unique ability to detect when something is wrong within a human system. By studying biomarkers, experts are able to discern when physiological damage or a disease is present within an individual, and can even categorize the specific issue. Biomarker research has concluded that it would be possible to detect Alzheimer's disease in its earliest stages, and potentially before any other type of detection currently available. To date, however, specific biomarkers for Alzheimer's haven't been identified or clinically validated. Research is headed in this direction by studying brain imaging and cerebral spinal fluid protein, while also utilizing genetic risk profiling. 

Brain Imaging

Because of the nature of Alzheimer's disease and its affect on the brain, brain imaging is another promising option for early detection. This would be the MRI, CT, or PET scans that have become common to perform when diagnosing any type of disorder to issue that's related to the brain. As Alzheimer's develops, amyloid plaque begins to build up in the brain, which shows up in brain imaging scans. Amyloid plaque can also be an indication of other disorders. Research seems to be farther along with brain imaging and closer to being able to implement more early detection testing in real world applications. There are even new brain imaging processes in the works that will help doctors identify Alzheimer's specifically without the use of radiation, and at a fraction of the cost of other brain scans. One such technique called arterial spin labeling, or ASL-MRI, requires about 20 additional minutes than a typical MRI, and is able to pinpoint changes in blood flow and increases in blood sugars that would be a symptom of Alzheimer's disease. 

Alzheimer's patients are among the individuals we commonly treat under hospice and palliative care at Cura-HPC. To learn more about our care options, contact us at 1-800-797-3839.